At a Glance

Why Get Tested?

When to Get Tested?

When you have a positive ANA test and signs and symptoms associated with lupus, such as persistent fatigue and weakness, arthritis-like pain in one or more joints, a red rash resembling a butterfly across the nose and cheeks, and/or skin sensitivity to light; periodically when you have been diagnosed with lupus

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

Anti-double stranded DNA antibody (anti-dsDNA) is one of a group of autoantibodies called antinuclear antibodies (ANA). Normally, antibodies protect against infection, but autoantibodies are produced when a person's immune system fails to adequately distinguish between "self" and "non-self." They mistakenly attack the body's own healthy cells, causing tissue and organ damage. Anti-dsDNA specifically targets the genetic material (DNA) found in the nucleus of a cell, hence the name "anti-dsDNA." The anti-dsDNA test identifies the presence of these autoantibodies in the blood.

While anti-dsDNA may be present at a low level with a number of disorders, it is primarily associated with lupus. Lupus is a chronic inflammatory autoimmune disorder that can affect various tissues and/or organs of the body such as the kidneys, joints, blood vessels, skin, heart, lungs, and the brain. (For more on this, read the article on Lupus). The test for anti-dsDNA, along with other autoantibody tests, may be used to help establish a diagnosis of lupus and distinguish it from other autoimmune disorders.

One serious complication of lupus is lupus nephritis, a condition characterized by inflammation of the kidneys, which can lead to protein in the urine, high blood pressure, and kidney failure. It occurs when the autoantibodies bind to antigens and become deposited in the kidneys. In the evaluation of someone with lupus nephritis, a high level (titer) of anti-dsDNA is generally associated with ongoing inflammation and damage to the kidneys.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Anti-dsDNA is one of a group of autoantibodies called antinuclear antibodies that are produced by a person's immune system when it fails to distinguish between "self" and "nonself." ANA target substances found in the nucleus of cells. Anti-dsDNA specifically target the genetic material (DNA) found in the nucleus, causing organ and tissue damage. The presence of anti-dsDNA in the blood is strongly associated with the autoimmune disorder lupus.

Typically, an ANA test is the first test performed to evaluate an individual for an autoimmune disorder. While a positive ANA test is seen in about 95% of lupus cases, it may be seen in many other conditions as well. The anti-dsDNA test is fairly specific for lupus; however, only 50-70% of people with lupus may be positive; that is, a negative anti-dsDNA does not rule out lupus. If a person has a positive ANA, an anti-dsDNA test may be used to distinguish lupus from other autoimmune disorders that have similar signs and symptoms.

An anti-dsDNA test may be ordered along with a test for anti-Sm (Smith antibody), another antinuclear autoantibody associated with lupus, to help establish a diagnosis. The anti-Sm test may be ordered as part of an extractable nuclear antigen (ENA) panel. Depending upon clinical signs and the health practitioner's suspicions, other autoantibodies may also be ordered to help distinguish between, and rule out, other autoimmune disorders. Examples include tests for histone antibody (drug-induced lupus) and antiphospholipid antibodies.

The anti-dsDNA test may be used to monitor the severity of the disease in a person who has been diagnosed with lupus. Those with lupus often have flare-ups in which symptoms worsen and then subside. An increased anti-dsDNA level may be seen prior to and during these flare-ups. In particular, this test may be used to monitor lupus nephritis, a serious complication of lupus that can cause kidney damage and inflammation. This can lead to protein in the urine, high blood pressure, and kidney failure. It occurs when the autoantibodies bind to antigens and become deposited in the kidneys.

When is it ordered?

An anti-dsDNA test is ordered when a person shows signs and symptoms that could be due to lupusand has had a positive ANA test, especially when the result of the ANA test presents as a "homogeneous" or "speckled" fluorescent pattern. (See the article on ANA for more on this.)

Examples of some signs and symptoms of lupus include:

Muscle pain

Arthritis-like pain in one or more joints (but no or little joint damage)

Red rash that frequently resembles a butterfly across the nose and cheek areas (malar rash)

Low-grade fever

Persistent fatigue, weakness

Skin sensitivity to light

Hair and weight loss

Numbness or tingling in the hands or feet

Inflammation and damage to organs and tissues, including the kidneys, lungs, heart, lining of the heart, central nervous system, and blood vessels

The anti-dsDNA test may be ordered periodically to monitor progress of the disease or flare-ups in a person who has been diagnosed with lupus. It may be repeated when an initial test result is negative but clinical signs and symptoms persist and lupus is strongly suspected.

What does the test result mean?

The results of an anti-dsDNA test are usually considered together with a person's medical history, signs and symptoms, and results of other autoantibody tests.

A high level of anti-dsDNA in the blood is strongly associated with lupus and is often significantly increased during or just prior to a flare-up. When the anti-dsDNA is positive and the person tested has other clinical signs and symptoms associated with lupus, it means that the person tested likely has lupus. This is especially true if an anti-Sm test is also positive.

In the evaluation of someone with lupus nephritis, a high level (titer) of anti-dsDNA is generally associated with ongoing inflammation and damage to the kidneys.

A very low level of anti-dsDNA is considered negative but does not exclude a diagnosis of lupus. Only about 50-70% of those with lupus will have anti-dsDNA.

Is there anything else I should know?

Anti-dsDNA tests are semi-quantitative tests and may be performed using different assays. Many laboratories use an anti-dsDNA ELISA test (enzyme-linked immunoabsorbent assay), a very reliable and sensitive test.

In addition to testing for anti-double-stranded DNA, there is also an anti-single-stranded DNA test. This autoantibody is less commonly tested and is not strongly associated with lupus but may be seen with other autoimmune disorders.

ANA consists of a group of antinuclear antibodies. If an ANA test is negative, it indicates that the entire group is negative. Since anti-dsDNA is a member of this group, it does not need to be ordered separately when an ANA test is negative.

1. Why might it take a long time to be diagnosed with lupus?

A health practitioner must rely not only test results, but on clinical symptoms and the person's history for a diagnosis. Symptoms may be nonspecific and often come and go. Test results may not initially be positive for some of these autoantibodies due to the cyclic nature of autoimmune disorders. In some cases, it may take months or years to show a pattern that might suggest lupus or any of the other autoimmune diseases.

6. Should everyone have an anti-dsDNA test done?

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Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

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This article was last reviewed on August 20, 2014. | This article was last modified on February 24, 2015.

The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.

The modified date indicates that one or more changes were made to the article. Such changes may or may not result from a full review of the article, so the two dates may not always agree.